Esophageal Adenocarcinoma, Gastric Cancer, Gastroesophageal Junction Cancer
Conditions
Brief summary
The main purpose of this study is to compare how long patients with gastric or gastroesophageal junction cancer live after receiving nivolumab and ipilimumab or nivolumab and chemotherapy compared with patients receiving chemotherapy alone.
Interventions
Specified dose on specified days
Specified dose on specified days
Specified dose on specified days
Specified dose on specified days
Specified dose on specified days
Specified dose on specified days
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or Female at least 18 years of age * Must have gastric cancer or gastroesophageal junction cancer that cannot be operated on and that is advanced or has spread out * Did not receive neoadjuvant or adjuvant treatment (chemotherapy, radiotherapy, or both) for their disease within the last 6 months * Must have full activity or, if limited, must be able to walk and carry out light activities such as light house work or office work * Must agree to provide tumor tissue sample, either from a previous surgery or biopsy within 6 months or fresh, prior to the start of treatment in this study
Exclusion criteria
* Presence of tumor cells in the brain or spinal cord that have not been treated * Active known or suspected autoimmune disease * Any serious or uncontrolled medical disorder or active infection * Known history of positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) * Any positive test result for hepatitis B or C indicating acute or chronic infection Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | From the date of randomization up to the date of death, up to approximately 17 months | Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 5. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
| Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months) | Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 5. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months) | Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms. |
| Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | From randomization until a clinically meaningful decline from baseline in GaCS score (approximately 10 months) | TTSD is defined as the the time from randomization until a clinically meaningful decline from baseline in Gastric Cancer Subscale (GaCS) score. A clinically meaningful deterioration is defined as a reduction of 8.2 points in the GaCS score. Subjects who do not deteriorate will be censored at the time of their last GACS assessment. Subjects without baseline GaCS assessment will be censored on the randomization date. Those with baseline GaCS, who do not have any GaCS assessments after randomization will be censored on the day after randomization. |
| OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | From the date of randomization up to the date of death, up to approximately 17 months | Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 1, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
| PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 9 months) | Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Ipilumab vs Chemotherapy with PD-L1 CPS ≥ 10, 5, 1 or all randomized participants. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
| Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months) | Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms. |
| OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | From the date of randomization up to the date of death, up to approximately 14 months | Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Ipilimumab vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 1, 5, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
| PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months) | Progression free survival (PFS), defined as the time from randomization to the date of the first documented progressive disease (PD) or death due to any cause, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy by BICR per RECIST1.1 in participants with PD-L1 CPS ≥ 10, 1, or all randomized subjects. Progreessive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100. |
Countries
Argentina, Australia, Brazil, Canada, Chile, China, Colombia, Czechia, France, Germany, Greece, Hong Kong, Hungary, Israel, Italy, Japan, Mexico, Peru, Poland, Portugal, Romania, Russia, Singapore, South Korea, Spain, Taiwan, Turkey (Türkiye), United Kingdom, United States
Participant flow
Pre-assignment details
2031 Participants Randomized and 1991 Treated
Participants by arm
| Arm | Count |
|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) Nivolumab + Xelox: Nivolumab 360 mg IV over 30 minutes on Day 1 of each treatment cycle, every 3 weeks + Oxaliplatin 130 mg/m2 IV on Day 1 of each treatment cycle + capecitabine 1000 mg/m2 orally twice daily (ie, 1000 mg/m2 in the morning and 1000 mg/m2 in the evening) on Days 1 to 14 of each treatment cycle, every 3 weeks
Nivolumab + Folfox: Nivolumab 240 mg IV over 30 minutes on Day 1 of each treatment cycle, every 2 weeks + Oxaliplatin 85 mg/m2 + leucovorin 400 mg/m2 + fluorouracil 400 mg/m2 IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours (or per local standard) daily on Days 1 and 2 of each treatment cycle, every 2 weeks | 789 |
| Arm 2: Chemotherapy (XELOX or FOLFOX) Chemotherapy (XELOX or FOLFOX): Xelox: Oxaliplatin 130 mg/m2 IV on Day 1 of each treatment cycle + capecitabine 1000 mg/m2 orally twice daily (ie, 1000 mg/m2 in the morning and 1000 mg/m2 in the evening) on Days 1 to 14 of each treatment cycle, every 3 weeks. Folfox: Oxaliplatin 85 mg/m2 + leucovorin 400 mg/m2 + fluorouracil 400 mg/m2 IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours (or per local standard) daily on Days 1 and 2 of each treatment cycle, every 2 weeks. This chemotherapy group consists of the two comparison chemotherapy sub-groups. Arm 2a (792 participants) is the comparison group to Arm 1 and Arm 2b (404 participants) is the comparison group to Arm 3. Some participants were counted in both Arm 2a and Arm 2b. | 833 |
| Arm 3: Nivolumab + Ipilimumab 1 mg/kg nivolumab administered IV over 30 minutes followed by ipilimumab 3 mg/kg administered IV over 30 minutes on Day 1 of each treatment cycle every 3 weeks for 4 doses (Cycles 1 to 4), followed by nivolumab 240 mg administered IV over 30 minutes on Day 1 of each treatment cycle every 2 weeks (Cycle 5 and beyond). Arm is closed to enrollment as of 05-June-2018. | 409 |
| Total | 2,031 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Pre-Treatment | Adverse event unrelated to study drug | 0 | 2 | 1 |
| Pre-Treatment | Disease Progression | 0 | 1 | 0 |
| Pre-Treatment | Other reasons | 1 | 2 | 2 |
| Pre-Treatment | Participant no longer meets study criteria | 4 | 0 | 0 |
| Pre-Treatment | Participants request to discontinue study treatment | 0 | 2 | 0 |
| Pre-Treatment | Participant withdrew consent | 2 | 20 | 3 |
| Treatment | Death | 121 | 94 | 68 |
| Treatment | Lost to Follow-up | 5 | 7 | 3 |
| Treatment | Other reasons | 13 | 12 | 5 |
| Treatment | Participant withdrew consent | 20 | 40 | 8 |
Baseline characteristics
| Characteristic | Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Arm 2: Chemotherapy (XELOX or FOLFOX) | Arm 3: Nivolumab + Ipilimumab | Total |
|---|---|---|---|---|
| Age, Continuous | 60.3 Years STANDARD_DEVIATION 11.9 | 59.8 Years STANDARD_DEVIATION 12.1 | 59.4 Years STANDARD_DEVIATION 11.7 | 59.9 Years STANDARD_DEVIATION 12 |
| Race (NIH/OMB) American Indian or Alaska Native | 12 Participants | 13 Participants | 1 Participants | 26 Participants |
| Race (NIH/OMB) Asian | 186 Participants | 200 Participants | 124 Participants | 510 Participants |
| Race (NIH/OMB) Black or African American | 7 Participants | 11 Participants | 6 Participants | 24 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 28 Participants | 39 Participants | 14 Participants | 81 Participants |
| Race (NIH/OMB) White | 556 Participants | 570 Participants | 264 Participants | 1390 Participants |
| Sex: Female, Male Female | 249 Participants | 246 Participants | 131 Participants | 626 Participants |
| Sex: Female, Male Male | 540 Participants | 587 Participants | 278 Participants | 1405 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 691 / 782 | 741 / 806 | 361 / 403 |
| other Total, other adverse events | 763 / 782 | 756 / 806 | 369 / 403 |
| serious Total, serious adverse events | 529 / 782 | 474 / 806 | 307 / 403 |
Outcome results
Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5
Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 5. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From the date of randomization up to the date of death, up to approximately 17 months
Population: All randomized participants with PD-L1 CPS ≥ 5
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | 14.39 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Overall Survival (OS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | 11.10 Months |
Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5
Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 5. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)
Population: All randomized participants with PD-L1 CPS ≥ 5
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | 7.69 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Progression Free Survival (PFS) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy With PD-L1 CPS ≥ 5 | 6.05 Months |
Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy
Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.
Time frame: From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)
Population: All randomized participants in various subsets as determined by PD-L1 CPS status
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 1 | 48.8 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 5 | 50.1 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 10 | 48.8 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 46.9 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 37.2 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 1 | 38.0 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 10 | 37.7 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with CPS ≥ 5 | 38.2 Percentage of Participants |
Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy
Objective response rate (ORR) as assessed by BICR in participants with PD-L1 CPS ≥ 10, 5, 1, or all randomized participants. ORR is a percentage of participants determined by the number of participants with a best overall response (BOR) of complete response (CR) or partial response (PR) divided by the number of measurable participants with target lesion at baseline. BOR is defined as the best response designation as determined by the BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1 as determined by the BICR) or the date of subsequent anti-cancer therapy, whichever occurs first. CR is defined as the disappearance of all target lesions. PR is define as at 30% decrease in the sum of diameters of target lesions. The 806 chemotherapy treated participants are split into two separate arms (Arm 2a and Arm 2b) to act as comparison groups to the other treatment arms.
Time frame: From randomization to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to approximately 43 months)
Population: All randomized participants in various subsets as determined by PD-L1 CPS status
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 1 | 37.3 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 5 | 37.7 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 10 | 35.9 Percentage of Participants |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 34.9 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 20.8 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 1 | 21.7 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 10 | 24.3 Percentage of Participants |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Objective Response Rate in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 5 | 23.1 Percentage of Participants |
OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy
Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy with PD-L1 CPS ≥ 1, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From the date of randomization up to the date of death, up to approximately 17 months
Population: All randomized participants with available OS measurements in various subsets
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 13.73 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-LI CPS ≥ 1 | 13.80 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 5 | 14.39 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 10 | 15.01 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 10 | 10.94 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 11.63 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 5 | 11.14 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-LI CPS ≥ 1 | 11.37 Months |
OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy
Overall survival (OS), defined as the time from randomization to the time of death, in participants treated with Nivolumab plus Ipilimumab vs Chemotherapy with PD-L1 CPS (combined positive score) ≥ 1, 5, 10, and all randomized participants. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From the date of randomization up to the date of death, up to approximately 14 months
Population: All randomized participants with available measurements in various subsets as determined by PD-L1 CPS status
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 11.83 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 5 | 11.63 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 10 | 11.33 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 1 | 11.47 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 10 | 11.63 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 11.73 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 1 | 11.73 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | OS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | Participants with CPS ≥ 5 | 11.24 Months |
PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy
Progression free survival (PFS), defined as the time from randomization to the date of the first documented progressive disease (PD) or death due to any cause, in participants treated with Nivolumab plus Chemotherapy vs Chemotherapy by BICR per RECIST1.1 in participants with PD-L1 CPS ≥ 10, 1, or all randomized subjects. Progreessive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 10 months)
Population: All randomized participants with available PFS measurements in various subsets
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 7.75 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 5 | 8.31 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 1 | 7.52 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 10 | 8.41 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 10 | 5.82 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | All randomized participants | 6.93 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 1 | 6.93 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | Participants with PD-L1 CPS ≥ 5 | 6.14 Months |
PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy
Progression Free Survival (PFS) is defined as the time from randomization to the date of the first documented PD or death due to any cause. PD is determined by blinded independent committee review (BICR) per RECIST1.1 criteria in participants treated with Nivolumab plus Ipilumab vs Chemotherapy with PD-L1 CPS ≥ 10, 5, 1 or all randomized participants. Progressive disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking in reference the smallest sum on study that also demonstrated an absolute increase of at least 5 mm. CPS is defined as the number of PD-L1 staining cells (tumor cells, lymphocytes, macrophages) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: From randomization to the date of the first documented progressive disease (PD) per BICR or death due to any cause (up to approximately 9 months)
Population: All randomized participants with available measurements in various subsets as determined by PD-L1 CPS status
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 7.06 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 1 | 6.93 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 5 | 6.28 Months |
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 10 | 6.28 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 10 | 2.89 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | All randomized participants | 2.83 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 5 | 2.83 Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | PFS in Participants Treated With Nivolumab Plus Ipilimumab vs Chemotherapy | PD-L1 CPS ≥ 1 | 2.79 Months |
Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy
TTSD is defined as the the time from randomization until a clinically meaningful decline from baseline in Gastric Cancer Subscale (GaCS) score. A clinically meaningful deterioration is defined as a reduction of 8.2 points in the GaCS score. Subjects who do not deteriorate will be censored at the time of their last GACS assessment. Subjects without baseline GaCS assessment will be censored on the randomization date. Those with baseline GaCS, who do not have any GaCS assessments after randomization will be censored on the day after randomization.
Time frame: From randomization until a clinically meaningful decline from baseline in GaCS score (approximately 10 months)
Population: All Treated participants with TTSD measurements
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm 1: Nivolumab + Chemotherapy (XELOX or FOLFOX) | Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | NA Months |
| Arm 2a: Chemotherapy (XELOX or FOLFOX) | Time to Symptom Deterioration (TTSD) in Participants Treated With Nivolumab Plus Chemotherapy vs Chemotherapy | 21.03 Months |